Reality TV has brought national attention to hoarding, and now a recent change in the influential psychiatric diagnosis guide may actually bring help for millions of Americans suffering from the isolating condition.
Hoarding - a psychological condition that can result in homes crammed floor to ceiling with papers, junk mail, books, clothing and other “valuables”— has been associated with obsessive-compulsive behavior, although experts have long held that the two disorders aren’t necessarily connected.
In the revised, fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), “hoarding disorder” becomes a separate diagnosis, characterized by a “persistent difficulty discarding or parting with possessions, regardless of their actual value.”
The revised diagnosis should “result in more people having access to treatment,” says Randy Frost, a professor of psychology at Smith College who specializes in hoarding issues. “Right now, there are very few clinicians who know how to treat it. Once it shows up in DSM, there will be much more pressure on clinicians to train in how to treat this problem.”
Hoarding isn’t just a messy garage or packed closet. According to the APA, it’s defined by its harmful effects — emotional, physical, social, financial and even legal — both on the hoarder and the hoarder’s family members.
ADHD, it’s diagnosis and treatment protocols are contentious issues. SC&A will present varying opinions on the matter in the following days.
Why French Kids Don’t Have ADHD—Part 1
In the United States, 5% of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?
Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the United States. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological-psycho stimulant medications such as Ritalin and Adderall.
French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children’s focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress—not in the child’s brain but in the child’s social context. They then choose to treat the underlying social context problem with psychotherapy or family counseling. This is a very different way of seeing things from the American tendency to attribute all symptoms to a biological dysfunction such as a chemical imbalance in the child’s brain.
French child psychiatrists don’t use the same system of classification of childhood emotional problems as American psychiatrists. They do not use the Diagnostic and Statistical Manual of Mental Disorders or DSM.According to Sociologist Manuel Vallee, the French Federation of Psychiatry developed an alternative classification system as a resistance to the influence of the DSM-3. This alternative was the CFTMEA(Classification Française des Troubles Mentaux de L’Enfant et de L’Adolescent), first released in 1983, and updated in 1988 and 2000. The focus of CFTMEA is on identifying and addressing the underlying psychosocial causes of children’s symptoms, not on finding the best pharmacological bandaids with which to mask symptoms.
I’m sitting beside a tall stack of books by Jerome Kagan, published by Harvard, Yale, Cambridge, Basic Books. This stack doesn’t include Kagan’s papers (nearly 400), or his textbook Psychology: An Introduction, written with Julius Segal, which has gone through at least nine editions.
A professor emeritus at Harvard, Kagan, now 83, began his career at Yale, where his apprenticeship to behavioral researcher Frank Beach required him to masturbate a group of male dogs over several evenings. Eventually he got a day job, assessing children for a longitudinal study of childhood temperament at the Fels Research Institute. He moved to Harvard in 1964 and continued to study children. His research culminated in The Nature of the Child (1984), a developmental study that emphasized the enduring role of temperament. Kagan went on to codirect Harvard’s Mind/Brain/Behavior Interfaculty Initiative, an interdisciplinary program established in 1993 to investigate relationships between the nervous system, human behavior, and mental life.
The themes of Kagan’s books widened accordingly, to include more philosophical and cultural questions. Indeed, Psychology’s Ghosts revisits ideas Kagan advanced in previous books, namely Three Seductive Ideas (1998), An Argument for Mind (2006), and The Three Cultures (2009)—the title of the latter an allusion to C. P. Snow’s influential lecture cautioning against the growing gulf between the sciences and the humanities. Where in 1959 Snow saw a schism, Kagan now sees a 21st-century Bermuda Triangle: social scientists, lost in the airspace between two great branches of knowledge, unwilling or unable to read the signals from either one.
Psychology’s Ghosts makes important criticisms of the profession: Psychologists should pay more attention to the setting, age, class, and cultural background of their research participants; researchers should look for patterns of measures rather than use single measures; and psychiatrists need to consider life circumstances rather than simply diagnosing patients and prescribing medication on the basis of symptoms. Kagan singles out the infamous Diagnostic and Statistical Manual of Mental Disorders for well-deserved scorn. However, most psychiatrists and psychologists see the DSM as not much more than a tool for billing insurance companies, so Kagan’s low opinion won’t be news to them.
ABOUT 40 YEARS AGO, American psychiatry faced an escalating crisis of legitimacy. All sorts of evidence suggested that, when confronted with a particular patient, psychiatrists could not reliably agree as to what, if anything, was wrong. To be sure, the diagnostic process in all areas of medicine is far more murky and prone to error than we like to think, but in psychiatry the situation was — and indeed still is — a great deal more fraught, and the murkiness more visible. It didn’t help that psychiatry’s most prominent members purported to treat illness with talk therapy and stressed the central importance of early childhood sexuality for adult psychopathology. In this already less-than-tidy context, the basic uncertainty regarding how to diagnose what was wrong with a patient was potentially explosively destabilizing.
The modern psychopharmacological revolution began in 1954 with the introduction of Thorazine, hailed as the first “anti-psychotic.” It was followed in short order by so-called “minor tranquilizers:” Miltown, and then drugs like Valium and Librium. The Rolling Stones famously sang of “mother’s little helper,” which enabled the bored housewife to get through to her “busy dying day.” Mother’s helper had a huge potential market. Drug companies, however, were faced with a problem. As each company sought its own magic potion, it encountered a roadblock of sorts: its psychiatric consultants were unable to deliver homogeneous populations of test subjects suffering from the same diagnosed illness in the same way. Without breaking the amorphous catchall of “mental disturbance” into defensible sub-sets, the drug companies could not develop the data they needed to acquire licenses to market the new drugs.
In a Cold War context, much was being made about the way the Soviets were stretching the boundaries of mental illness to label dissidents as mad in order to incarcerate and forcibly medicate them. But Western critics also began to look askance at their own shrinks and to allege that the psychiatric emperor had no clothes. A renegade psychiatrist called Thomas Szasz published a best-selling broadside called The Myth of Mental Illness, suggesting that psychiatrists were pernicious agents of social control who locked up inconvenient people on behalf of a society anxious to be rid of them, invoking an illness label that had the same ontological status as the label “witch” employed some centuries before. Illness, he truculently insisted, was a purely biological thing, a demonstrable part of the natural world. Mental illness was a misplaced metaphor, a socially constructed way of permitting an ever-wider selection of behaviors to be forcibly controlled under the guise of helping people.
he latest trend on the internet is to step away from the internet, according to a growing band of American technology leaders and psychologists for whom the notion of the addictive power of digital gadgets is gaining sway.
Although the idea of a clinical disorder of internet addiction was first mooted in the 90s and is now regularly treated by doctors on both sides of the Atlantic, attention is shifting from compulsive surfing to the effects of the all-pervasive demands that our phones, laptops, tablets and computers are making on us.
In China, Taiwan and Korea, internet addiction is accepted as a genuine psychiatric problem with dedicated treatment centres for teenagers who are considered to have serious problems with their web use. Next year, America’s Diagnostic and Statistical Manual of Mental Disorders, the authority on mental illness, could include “internet use disorder” in its official listings.
In February, leaders of the largest social media companies will gather in San Francisco for the Wisdom 2.0 conference. The theme for the \conference, attended by some of Silicon Valley’s biggest names, is finding balance in the digital age. Richard Fernandez, Google’s development director, has called it “quite possibly the most important gathering of our times”.
More than any previous group of American youth, Chandra Watts and her peers grew up hearing about ADHD, bipolar, and Prozac.
As a generation, they were more psychologically attuned — and diagnosed — than any other. Mental disorders, they were told, should be viewed no differently from physical illnesses, and cause no shame.
So when Watts was 15 and hospitalized in the midst of severe mood swings, she thought she could safely confide in a good friend. But that friend ended up telling someone else, who told someone else, and then word got out. Watts was devastated.
“I became known as the School Crazy,” said Watts, now 25 and attending community college in Worcester.
Chandra Watts is part of a program called Strategic Sharing, which helps young people who have struggled with mental health issues talk about their past in selective ways.
Seasoned by that experience, but undaunted, Watts is among a growing number of young people wrestling with a political and personal dilemma: They want to lead efforts to curb long-held prejudices against people with mental illness, but must carefully consider what they say publicly to protect their image as they enter the adult world. They also face challenges not confronted by previous generations: The Internet and social networking sites can turn casual remarks into permanent records, easily searched by college admissions officers and potential employers.
‘The majority of people are judgmental.’
Several national efforts are underway to help young people with this problem. YouthMOVE Massachusetts, part of a national group focused on youth mental health issues, is sponsoring a program next month called Strategic Sharing, in which Watts and others will learn when and how to filter what they say, depending on the situation. This program, created by Casey Family Programs, counsels young people with mental illness how to promote awareness of psychiatric issues but not share too much that might hurt them on the job or in new relationships.
A program called LETS (Let’s Erase The Stigma), launched two years ago in Southern California, has drawn several thousand teenagers to form school chapters to increase understanding and acceptance of mental illness, said Phil Fontilea, the founder and a former business executive with his own history of depression
Children who are spanked, hit, or pushed as a means of discipline may be at an increased risk of mental problems in adulthood — from mood and anxiety disorders to drug and alcohol abuse, new research suggests.
Although it is well established that physical and sexual abuse, emotional neglect, and other severe forms of maltreatment in childhood are associated with mental illness, this is one of the first studies to show a link between non-abusive physical punishment and several different types of mental disorders, says epidemiologist Tracie Afifi, lead author of the study in today’s Pediatrics.
“There is a significant link between the two,” says Afifi, an assistant professor of epidemiology in the Department of Community Health Sciences at the University of Manitoba, Canada. “Individuals who are physically punished have an increased likelihood of having mental health disorders.” Approximately 2% to 7% of mental disorders in the study were linked to physical punishment, she says.
The study’s findings add evidence to the argument that “physical punishment should not be used on any child, at any age,” she says.
Parents’ right to use physical punishment has been abolished in more than 30 nations, but not in the USA or Canada, says the Global Initiative to End All Corporal Punishment, endorsed by the United Nations and others
The first week in May brought a new leader in France and new prospects for same sex couples seeking marriage. But at the American Psychiatric Association’s annual meeting in Philadelphia, attended by 11,000 psychiatrists, it was the same old same old. Instead of listening to the public outcry about overmedicated children, soldiers, elderly and everyday people watching too many drug ads, the psychiatry group re-affirmed its resolve to pathologize healthy people and even rolled out new groups to target.
This is the year the APA puts the finishing touches on DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, a compendium that determines what treatments insurers will cover, what disorders merit funding as “public health” threats and of course, Pharma marketing and profits. Some question the objectivity of a disorder manual written by those who stand to benefit from an enlarged patient pool and new diseases. Furthering the appearance of self-dealing is the revelation that 57 percent of the DSM-5’s authors have Pharma links.
No kidding. Present at this year’s meeting were former APA president Alan F. Schatzberg, MD and Charles Nemeroff, MD, both investigated by Congress for murky Pharma income. Schatzberg and Nemeroff are co-editors of the APA-published Textbook of Psychopharmacology whose 2009 edition cites the work of Richard Borison, MD former psychiatry chief at the Augusta Veterans Affairs medical center who was sentenced to 15 years in prison for a $10 million clinical trial fraud. Also present was S. Charles Schulz, MD, who was investigated for financial links to AstraZeneca believed to alter his scientific conclusions.
Even though Assistant Secretary of Defense Jonathan Woodson sent a memo to all branches of the military in February about overprescription of antipsychotic medications like Seroquel and Risperdal for PTSD, military figures closely linked to that overprescription were also listed in attendance at the APA meeting.
Are you ever worried that you (or a loved one) have mental problems that require professional attention? If not, then maybe you should be. Consider the following list of symptoms:
- Do you binge out on forbidden foods [Häagen-Dazs, Cheetos] more than a couple of times a month?
- Were you extremely sad and depressed for a month or two after your mother died, or even longer?
- Does your seven-year-old have frequent temper tantrums?
- Do you get cranky before your period?
- Are you forgetting more things than you used to?
If you answered yes to any of these questions, beware. Taken from the top, these behaviours could be symptoms of: Binge Eating Disorder, Major Depressive Disorder, Disruptive Mood Dysregulation Disorder (or possibly an even more serious condition, Child Bipolar Disorder), Premenstrual Attention Deficit Disorder, and Mild Neurocognitive Disorder. All of these conditions could wind up in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), due out next year.
The DSM, which is used by doctors, clinicians, health-care providers, social workers and insurance companies, is the bible of psychiatry. It has a big impact on the way millions of people lead their lives and on the way mental health resources are spent. Now it has become the focus of a fierce controversy over the distinctions between normal and abnormal behaviour, the role of pharmaceutical marketing in the treatment of mental illness, the overtreatment of children and the medicalization of the ups and downs of everyday life.
“We’re being overdosed and overmedicated,” says Allen Frances, professor emeritus at Duke University, who is a leading critic of the DSM and of what’s known as “diagnostic inflation.”
The far right think tanks and anti abortion groups have been commissioning pseudo-scientific studies and papers for publication in vanity journals and other places for a couple of decades to use as backing for bills to limit abortion. This is just one of them, there are many others that need debunking as well. Prior to this it was “Fetal Pain” until that was also thoroughly debunked. [Also see here.]
You can bet that right now there are zealots commissioning more pseudo science studies to serve as new vehicles for laws to limit abortion. It’s time for the scientific community to start responding faster and more firmly when confronted with these religion driven lies, just as they do when Discovery Institute shills attack evolution or global warming.
In looking for mental health disorders (like panic attacks, depression, substance abuse and post traumatic stress disorder) associated with abortion, Priscilla Coleman of Bowling Green State University and her co-authors included all lifetime mental health disorders in their analysis, rather than only those instances occurring after the abortion took place. They were “hoping,” she says in a letter defending her methodology, “to capture as many cases of mental health problems as possible,” by including a longer period of time. In a detailed re-analysis of the (publicly available) data used in the study, Julia Steinberg of the University of California at San Francisco and Lawrence Finer of the Guttmacher Institute found what they called, in a letter to the journal’s editors, “untrue statements about the nature of the dependent variables and associated false claims about the nature of the findings.”
“This is not a scholarly difference of opinion,” Dr. Steinberg said. “Their facts were flatly wrong. This was an abuse of the scientific process to reach conclusions that are not supported by the data.”
Dr. Coleman’s work has been used to support state laws in seven states (Michigan, Nevada, North Carolina, South Dakota, Texas, Utah and West Virginia) requiring that women seeking an abortion be counseled regarding its negative psychological effects. A similar analysis of data in Denmark (reported last year in the British Journal of Medicine) found no support for the hypothesis that abortion increased the risk of mental disorders.
More on Priscilla Coleman here